Certificate of need (CON) laws are restricting access to innovative cancer immunotherapies in Michigan, according to Reason. Immunotherapies attempt to program the body's own immune system to attack and kill cancer cells, and have become an increasingly attractive way to combat cancer. However, under new rules adopted by the Michigan Certificate of Need Commission, hospitals will need to go through third-party accreditation processes before being able to offer these CAR T-cell therapies. Though cancer research organizations, patient advocates and pharmaceutical companies oppose the new accreditation requirements, the University of Michigan Health System, the largest in the state, argue they are necessary for patient safety. CON laws vary from state to state but require that hospitals get a state agency’s permission before offering new services, expanding facilities or installing new medical technology.
For the second year in a row, Marylanders will see cheaper premiums for Affordable Care Act policies purchased on Maryland's health insurance exchange, according to the Washington Post. State officials announced that over 190,000 people will experience lower premium costs, with an average decline of 10.3 percent for individual plan prices. Insurance regulators attribute the decline to the healthcare reinsurance plan that state officials created in 2018, paid for by a tax on insurance companies. However, the cost for around 269,000 small-group plans in the state will increase by 3 percent, significantly less than what insurance companies had proposed.
The Wisconsin Collaborative for Healthcare Quality issued a report identifying where gaps in health outcomes and care exist within the state. The report highlighted widespread racial and ethnic disparities, with American Indian/Alaskan Native children experiencing much lower childhood vacination rates, Asian/Pacific Islander adults having much lower rates of breast and colorectal cancer screenings and Black adults with diabetes or heart disease being much less likely to be tobacco-free. The report also highlighted payer disparities, noting that those with Medicare had much lower cervical cancer screening rates. Finally, the report noted limited rural/urban disparities, but that these ay have been related to the use of only two categories to describe rural and urban areas, potentialy masking disparities in these areas.
As health plans prepare to submit rate filings, a new report from Oregon’s Division of Financial Regulation’s Prescription Drug Price Transparency Program illuminates just how much prescription drug prices impact insurance premiums. Oregon requires health plans to report on: per member, per month (PMPM) drug costs; top 25 drugs responsible for the greatest increase in planning spending; top 25 most costly prescription drugs; and the top 25 most frequently prescribed medications. Based on 2018 data, on average, drug costs represented 14 percent of premium rates in Oregon. Abbvie’s Humira, a biologic used to treat various autoimmune diseases, topped the list as both the most costly and the largest contributor to increases in plan spending.
Air ambulance companies have begun advertising memberships to rural Kansans in the wake of recent hospital closures, prompting concerns that the companies are exploiting vulnerable patients, reports KCUR. Although the membership programs promise to protect customers from out-of-pocket expenses, the contractual fine print often undermines the advertised intent. For example, privately insured patients who purchase memberships would still receive a bill and must work through their insurance company’s claims, denial and appeal processes. Additionally, air ambulance companies can end memberships at any time without obligation to notify the customer. North Dakota and Montana ban or heavily regulate the memberships in attempt to better protect consumers.
University Hospital in Newark, New Jersey, has partnered with Hitch Health to help patients with appointments for select services to get free rides to and from those appointments via Lyft or medical transport vehicles, if necessary, according to NJ Spotlight. The service was designed to help the overwhelming majority of Newark parients who frequently use its services and for whom getting to the facility is a major challenge. Hitch's system integrates patients' electronic health records, allowing them to identify eligible patients and connect with them in advance, making the service easier for both doctors and patients.
A recent report by the Wisconsin Collaborative for Healthcare Quality revealed wide variation in how people in the state experience health outcomes and care, which is influenced by many factors. The report found substantial disparities across several measures. For example, the data show that Black Wisconsinites experience substantial disparities (defined as 10 percent lower than the best performing group) for childhood vaccinations, weight management, blood pressure control, tobacco use, and diabetes or heart disease prevalence. Many outcomes were stratified by race and payers or insurers. For instance, those who were uninsured or have Medicaid experienced similar and substantial disparities in nearly every measure compared to those with commercial or Medicare coverage. The Wisconsin Collaborative for Healthcare Quality hopes this data will be used to increase health equity within the state.
Marketwide price information at the insurer-provider-service levels could help target policy interventions to reduce healthcare spending, according to a simulation reported in Health Affairs. Researchers examined variation in fee-for-service commercial prices in Massachusetts for 291 predominantly outpatient medical services and found that prices varied considerably across hospital service areas. Prices for medical services at acute hospitals were, on average, 76 percent higher than at all other providers. The service categories with the widest price variation were ambulance/transportation services, physical/occupational therapy and laboratory/pathology testing. In this market, simulations suggested that steering patients toward lower-price providers or setting price ceilings could generate potential savings of 9–12.8 percent.
The North Carolina Department of Health and Human Services will partner with Phreesia, a patient intake platform, to address individuals' social determinants of health using real-time data and screening questions, according to HealthITAnalytics. The platform provides screening questions to help healthcare organizations identify patients with unmet social needs and can send real-time alerts to providers and care coordinators about patients' individual needs. A large number of North Carolina residents struggle in finding affordable housing and with food insecurity. It is hoped that this initiative will reduce costs, improve outcomes and increase patient satisfaction, as previous studies have shown addressing social determinants of health can do.
Residents say the only hospital in Carlsbad, N.M. is notorious for suing its patients, adding in lots of mystery charges and refusing to give itemized bills, reports CNN. When patients can’t pay, the hospital will sometimes sue them to collect the money. An investigation of court records shows that in the past 10 years, Carlsbad Medical center has sued more than 3,000 people to collect debts. In a statement, the hospital CEO said they sue fewer than one percent of the patients who receive care at the hospital. Still, most other hospitals in the area haven’t sued any patients for debt collection over the past 10 years.